Department of Medicine, Alice Springs Hospital, PO Box 2234, Alice Springs, NT, 0871, Australia.
Bankstown-Lidcombe Hospital, Sydney, Australia.
BMC Infect Dis. 2021 Jul 9;21(1):671. doi: 10.1186/s12879-021-06372-5.
Pseudomonas aeruginosa bacteraemia (PAB) is associated with high mortality. The benefits of infectious diseases consultation (IDC) has been demonstrated in Staphylococcal aureus bacteraemia and other complex infections. Impact of IDC in PAB is unclear. This study aimed to evaluate the impact of IDC on the management and outcomes in patients with PAB.
This is a retrospective cohort single-centre study from 1 November 2006 to 29 May 2019, in all adult patients admitted with first episode of PAB. Data collected included demographics, clinical management and outcomes for PAB and whether IDC occurred. In addition, 29 Pseudomonas aeruginosa (PA) stored isolates were available for Illumina whole genome sequencing to investigate if pathogen factors contributed to the mortality.
A total of 128 cases of PAB were identified, 71% received IDC. Patients who received IDC were less likely to receive inappropriate duration of antibiotic therapy (4.4%; vs 67.6%; p < 0.01), more likely to be de-escalated to oral antibiotic in a timely manner (87.9% vs 40.5%; p < 0.01), undergo removal of infected catheter (27.5% vs 13.5%; p = 0.049) and undergo surgical intervention (20.9% vs 5.4%, p = 0.023) for source control. The overall 30-day all-cause mortality rate was 24.2% and was significantly higher in the no IDC group in both unadjusted (56.8% vs 11.0%, odds ratio [OR] = 10.63, p < 0.001) and adjusted analysis (adjusted OR = 7.84; 95% confidence interval, 2.95-20.86). The genotypic analysis did not reveal any PA genetic features associated with increased mortality between IDC versus no IDC groups.
Patients who received IDC for PAB had lower 30-day mortality, better source control and management was more compliant with guidelines. Further prospective studies are necessary to determine if these results can be validated in other settings.
铜绿假单胞菌菌血症（PAB）与高死亡率相关。传染病咨询（IDC）在金黄色葡萄球菌菌血症和其他复杂感染中的益处已得到证实。IDC 对 PAB 的影响尚不清楚。本研究旨在评估 IDC 对 PAB 患者管理和结局的影响。
这是一项回顾性队列单中心研究，纳入 2006 年 11 月 1 日至 2019 年 5 月 29 日期间所有因首次发生 PAB 而住院的成年患者。收集的数据包括患者人口统计学、PAB 的临床管理和结局以及是否发生 IDC。此外，还获得了 29 株铜绿假单胞菌（PA）储存分离株进行 Illumina 全基因组测序，以研究病原体因素是否导致死亡率增加。
共确定了 128 例 PAB 病例，71%的患者接受了 IDC。接受 IDC 的患者接受抗生素治疗时间不当的可能性较低（4.4% vs. 67.6%；p<0.01），及时降阶梯为口服抗生素的可能性较高（87.9% vs. 40.5%；p<0.01），感染导管的去除率较高（27.5% vs. 13.5%；p=0.049），手术干预率较高（20.9% vs. 5.4%；p=0.023），以进行源控制。总体 30 天全因死亡率为 24.2%，未接受 IDC 的患者在未调整（56.8% vs. 11.0%，比值比 [OR] = 10.63，p<0.001）和调整分析（调整 OR = 7.84；95%置信区间，2.95-20.86）中均显著更高。基因分型分析未发现 IDC 组与非 IDC 组之间与死亡率增加相关的任何 PA 遗传特征。
接受 IDC 治疗的 PAB 患者 30 天死亡率较低，源控制和管理更好，更符合指南。需要进一步的前瞻性研究来确定这些结果是否可以在其他环境中得到验证。
